See one, do one, teach one[horizontal ellipsis]faculty in our school of nursing took this expression to heart and implemented a peer coaching program across the prelicensure nursing curriculum, with goals of enhancing students' understanding of skills, communication, teamwork, collaboration, and safety in nursing practice. This program gives each junior and senior student an opportunity to volunteer as a peer coach for sophomore and junior students in a variety of settings such as clinical orientation, simulation, and clinical boot camp. Over the past few years of implementing peer coaching across the curriculum, faculty and students have identified multiple benefits such as opportunity to share one's knowledge and clinical skills with others.

Literature Review

In recent years, peer-assisted learning has also been prominent in the medical literature.1,2 Schwellnus and Carnahan3 identified that the "coaching philosophy adheres to the notion that learning is never finished and to reach one's maximum potential requires an external viewpoint to correct or enhance performance."

Minha et al4 used peer-assisted learning in a patient/physician student simulation workshops for medical students. Eighty-five percent of the students reported that the workshops were important to their training, and 87% agreed they should be mandatory.4 The authors believed peer-assisted learning helped establish a safe environment to promote confidence and provide an opportunity to practice several skills at once.

A literature review noted various ways in which organizations have used peer coaching. One attempt at situated peer coaching was used in a fundamentals skills laboratory.5 As the semester progressed, students enjoyed completing unfolding case studies in which they were given personal feedback by their coach. Students were comfortable with peer coaching and the scores on their skill performance. In addition, peer coaching allowed them to focus on safety issues, practice collaboration, and hone their critical thinking skills-all vital to professional practice.

Peer coaching was implemented as a team-based approach by McQuiston and Hanna.6 The authors suggested that peer coaching decreased novice students' anxiety. In another school, McKenna and French1 organized a boot camp for first-year nursing students that consisted of skill stations manned by senior-level nursing students. The learning experiences of beginning students were enhanced by graduating nursing students, who also gained knowledge and skills as educators.1 Potential benefits of coaching include provision of feedback, reinforcement of learning, role modeling, teamwork, and communication.1 In our school of nursing, faculty believed peer coaching would allow for enhanced student engagement in a relaxed environment.

Methods to Implement Peer Coaching

Boot Camp

Boot camp was developed as a 1-day laboratory at the start of each new semester for review and promotion of proficiency of skills for students. The morning session uses senior students to check off junior students on skills, and the afternoon session consists of junior students checking off sophomores. Before the start of the boot camp, students who would be functioning as peer coaches review and demonstrate their skill sets to faculty, assist with setup, and ensure needed supplies are available. Each skill station, with 10 sophomore or junior students, is manned by 3 peer coaches. Faculty are present at each station for additional guidance and feedback as necessary. Students expressed positive satisfaction with the boot camp and reported less anxiety while demonstrating skills in front of a peer coach rather than a faculty member.

Clinical Orientation

In the past, a clinical instructor would provide clinical orientation to approximately 10 students. Rather than this traditional method, the instructor implemented the use of peer coaches to provide a one-to-one clinical orientation for all new students on the unit. Novice nursing students on their first clinical day in a hospital are paired with junior students for orientation. The juniors also assist students with their initial head-to-toe assessments, documentation, and communication skills. The objectives of peer coaching during clinical orientation are to support and encourage the beginning students and promote teamwork/collaboration.

Simulation

Faculty also use senior students as peer coaches during pharmacology, maternal-child, pediatric, and medical/surgical simulation activities. Peer coaches guide learning in the simulation and facilitate the debriefing using the Socratic method of questioning. For example, if the novice student asked, "What should I do next?", the peer coach does not answer directly but guides the student through the decision-making process using questions. Peer coaches participate in the debriefing process, offering encouragement and feedback. The novice students noted that having their peer coaches present during simulation and debriefing decreased their anxiety.

Conclusion

Faculty believe peer coaching promotes teaching skills, professional interactions, higher level thinking, improved organization and prioritization of care, and development of collaboration and teamwork skills among students. Students reported that juniors and seniors acting as peer coaches decreased their anxiety. Regardless of where the activity is performed, students as peer coaches gain experience in teaching.

The idea of peers assisting one another to learn has been around for many years. This method has shown to improve student outcomes, reduce cost, and facilitate guidance through a formative assessment.1,4-6 Peer coaching promotes self-confidence while protecting faculty time. It is proposed that, because peers communicate with one another on a similar level, they can often describe complex concepts more efficiently, thus decreasing students' anxiety.

References